Raised ICP and traumatic brain injury management

^[1]

A young man with severe diffuse TBI has a high ICP and a low-normal MAP, giving a CPP well below target — and the Seattle algorithm (SIBICC) says what to do next, in tiers.^[1]

Monitoring — who gets what

ICP monitoring is associated with mortality when ICP rises; management guidelines recommend keeping physiological ICP to prevent herniation and inadequate cerebral blood flow.^[20] The EVD both measures and drains; ventriculostomy-related infection and haemorrhage are the recognised complications.^[24]

Optic nerve sheath diameter on ultrasound is a strong contender among bedside non-invasive modalities, estimating ICP from optic nerve distension . A scoping review compares its use against gold-standard invasive methods rather than replacing them.^[9]

References30ShowHide

1. [1]Hawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive care medicine, 2019.PMID 31659383
2. [2]Hawryluk GWJ, Rubiano AM, Totten AM, et al. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurgery, 2020.PMID 32761068
3. [3]Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. The New England journal of medicine, 2016.PMID 27602507
4. [4]Cooper DJ, Nichol AD, Bailey M, et al. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. JAMA, 2018.PMID 30357266
5. [5]Chesnut RM, Temkin N, Videtta W, et al. Consensus-Based Management Protocol (CREVICE Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed. Journal of neurotrauma, 2020.PMID 32013721
6. [6]Schizodimos T, Soulountsi V, Iasonidou C, et al. An overview of management of intracranial hypertension in the intensive care unit. Journal of anesthesia, 2020.PMID 32440802
7. [7]Dietvorst S, Depreitere B, Meyfroidt G Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury. Current opinion in critical care, 2023.PMID 36762674
8. [8]Kochanek PM, Adelson PD, Rosario BL, et al. Comparison of Intracranial Pressure Measurements Before and After Hypertonic Saline or Mannitol Treatment in Children With Severe Traumatic Brain Injury. JAMA network open, 2022.PMID 35267036
9. [9]Martínez-Palacios K, Vásquez-García S, Fariyike OA, et al. Using Optic Nerve Sheath Diameter for Intracranial Pressure (ICP) Monitoring in Traumatic Brain Injury: A Scoping Review. Neurocritical care, 2024.PMID 38114797
10. [10]Liu M, Wang AJ, Chen Y, et al. Efficacy and safety of erythropoietin for traumatic brain injury. BMC neurology, 2020.PMID 33138778
11. [11]Michael R, Gaddy M, Antonino N, et al. Hypertonic Saline for Severe Traumatic Brain Injury With Herniation: A Military Prehospital Case Report. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2022.PMID 35862837
12. [12]Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine, 2012.PMID 23234472
13. [13]Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. The New England journal of medicine, 2011.PMID 21434843
14. [14]Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery, 2017.PMID 27654000
15. [15]SAFE Study Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group, Australian Red Cross Blood Service, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. The New England journal of medicine, 2007.PMID 17761591
16. [16]Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet (London, England), 2004.PMID 15474134
17. [17]Le Roux P, Menon DK, Citerio G, et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive care medicine, 2014.PMID 25138226
18. [18]van Veen E, van der Jagt M, Citerio G, et al. Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study. Intensive care medicine, 2021.PMID 34351445
19. [19]Roberts I, Sydenham E Barbiturates for acute traumatic brain injury. The Cochrane database of systematic reviews, 2012.PMID 23235573
20. [20]Stein KY, Froese L, Gomez A, et al. Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives. Neurotrauma reports, 2023.PMID 37636334
21. [21]Okonkwo DO, Shutter LA, Moore C, et al. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine, 2017.PMID 29028696
22. [22]Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. Journal of neurosurgery, 1991.PMID 1919695
23. [23]Chesnut RM Secondary brain insults after head injury: clinical perspectives. New horizons (Baltimore, Md.), 1995.PMID 7496744
24. [24]Chadwick S, Donaldson L, Janin P, et al. The association between ventriculostomy - Related infection and clinical outcomes: A systematic review and meta-analysis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2023.PMID 36827759
25. [25]Maguigan KL, Dennis BM, Hamblin SE, et al. Method of Hypertonic Saline Administration: Effects on Osmolality in Traumatic Brain Injury Patients. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2017.PMID 28215427
26. [26]Martinez-Tejada I, Arum A, Wilhjelm JE, et al. B waves: a systematic review of terminology, characteristics, and analysis methods. Fluids and barriers of the CNS, 2019.PMID 31610775
27. [27]Temkin NR Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials. Epilepsia, 2001.PMID 11440347
28. [28]Andrews PJ, Sinclair HL, Rodriguez A, et al. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. The New England journal of medicine, 2015.PMID 26444221
29. [29]Skolnick BE, Maas AI, Narayan RK, et al. A clinical trial of progesterone for severe traumatic brain injury. The New England journal of medicine, 2014.PMID 25493978
30. [30]Wright DW, Yeatts SD, Silbergleit R, et al. Very early administration of progesterone for acute traumatic brain injury. The New England journal of medicine, 2014.PMID 25493974